TX HHS Form 3103. Cardiac Evaluation Report

The TX HHS Form 3103, Cardiac Evaluation Report, is a crucial tool for determining eligibility and developing a plan for rehabilitation services for individuals with cardiac-related disabilities. This form helps healthcare professionals and counselors gather essential information about the individual's medical history, symptoms, and physical findings to provide targeted support.

The report requires key information such as birth date, social security number, telephone number, reported disability, reason for referral, and condensed medical history regarding onset, duration, severity, and symptoms. Important sections include Medical History, which condenses the individual's cardiac-related symptoms and physical findings, such as palpitations, dyspnea, peripheral edema, depression, anxiety, and other pertinent physical findings.

This form is typically used when an individual seeks rehabilitation services for a cardiac-related disability or condition. Healthcare professionals and counselors can use this report to identify the individual's specific needs and develop a personalized plan for rehabilitation, ensuring they receive the necessary support to manage their condition effectively. The TX HHS Form 3103, Cardiac Evaluation Report, plays a vital role in facilitating timely and appropriate care for individuals with cardiac-related disabilities.